Adult: AortaReappraisal of the role of motor and somatosensory evoked potentials during open distal aortic repair
Graphical abstract
Impact of intraoperative MEP and SSEP loss on SCI during open distal aortic repair is demonstrated.
Section snippets
Materials and Methods
The Committee for Protection of Human Subjects, the local Institutional Review Board, approved this study. This study used a historical cohort design, using risk factor and outcome data from our department's prospective registry. Patients who underwent open distal aortic repair (descending thoracic and TAAA) with both MEP and SSEP monitoring during December 2004 and December 2019 were included in the study. Indications for surgical interventions included symptomatic aneurysm, aneurysm size
Results
Of 930 open distal aortic repairs performed during the study period, both SSEP and MEP were recorded on 822 patients. Of 822 SSEP measurements, 202 were missing popliteal fossa measurements. Both MEP and SSEP were intact for the duration of surgery in 348 patients (42%). A total of 283 patients (34%) had isolated MEP loss, 18 patients (3%) had isolated SSEP loss, and 173 patients (21%) had both MEP and SSEP loss. Preoperative patient characteristics are summarized in Table 1, and intraoperative
Discussion
Our data showed that isolated MEP loss and the combination of MEP and SSEP loss were predictive of immediate and delayed-onset SCIs (Figure 6). It is not surprising that patients without return of lost signals—which indicate ongoing damages in the ventral and posterior spinal cord—had higher ORs for immediate SCI compared with patients who had only transient signal changes as normal MEP and SSEP at the conclusion of surgery. The predictabilities of immediate SCI with transient MEP and SSEP loss
Conclusions
SSEP and MEP are both important monitoring measures to predict and prevent SCI during distal aortic repairs (Video 1). When these signals were interrupted, and especially when both were affected, rates of immediate SCI were high—especially when those were not regained at the conclusion of the procedures. In addition, intraoperative MEP and SSEP loss were associated with delayed SCI.
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